Reconsidering sex-based stereotypes of COPD

Abstract

Chronic obstructive pulmonary disease (COPD) has historically been considered a disease of older, white, male smokers, as illustrated in Frank Netter's classic images of the 'pink puffer' and 'blue bloater'. However, women may be more susceptible to COPD than men, and the disease course may be reflective of that increased susceptibility. From a review of epidemiological data of COPD, we found differences in the way men and women present with COPD symptoms, a bias in the way COPD symptoms are treated in men and women, and differences in susceptibility to airway obstruction based on age, sex, and smoking history. These data show that classic stereotypes of COPD -including male predominance -should be abandoned, and that there are not two but multiple COPD phenotypes, which are characterised by differences between women and men in susceptibility, symptoms, and disease progression. These differences impact on physician perception. Although further research into this concept is needed, the differences we found should prompt, in the short term, changes in the way (and in whom) COPD is evaluated, diagnosed, and treated; in the long term, these differences should prompt research into the prognosis of COPD based on sex differences.

Gender differences in the T-cell profiles of the airways in COPD patients associated with clinical phenotypes

“…Extensive studies have shown that females have more severe symptoms compared to males, despite a shorter smoking history and a similar degree of obstruction and emphysema 26. Several underlying molecular reasons for this could be proposed as previously reported while analyzing BAL-cell proteome from the same cohort 17…”

“…More respiratory symptoms and deteriorating lung function are reported for post-menopausal females, and a protective role for estrogen in the development of COPD has been proposed 26. Among others, it has been shown to stimulate the expansion of CD4 + CD25 + T regulatory cells33 important for controlling inflammation.…”

Sex and gender differences in COPD: challenging the stereotypes

“…Although COPD has historically been considered a disease of male smokers, it now clearly impacts on both sexes. 4 As Ohar, Fromer, & Donohue point out in this helpful review, 5 the paradigm of COPD is changing from a male-predominant two-category disorder, to a disorder characterised by multiple co-morbidities with a growing female prevalence.…”

“…This review 5 highlights key research areas in COPD where sex and gender stereotypes can be challenged -including disease susceptibility, symptoms, treatment, prognosis, and diagnosis. Although biological determinants of sex and age differences in airway behaviour (dimensional, immunological, and hormonal) have been known for many years, 6 there are still major gaps in our knowledge about COPD phenotypes.…”

“…depression, anxiety) in COPD. 5 Such differences in self-report and even prevalence could, at least in part, be explained by sex differences in the physiological response to stress, and gender differences in the types of stressors to which an individual is likely to be exposed. In turn, the nature of stressors may influence sex differences in physiological reactivity to stress, 9 with genderspecific impact on perception of symptoms, information processing, and role expectations.…”